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Fujita Y, Khoo HM, Kimoto Y, Emura T, Iwata T, Matsuhashi T, Miura S, Yanagisawa T, Hosomi K, Tani N, Oshino S, Hirata M, Kishima H. Accuracy of Boltless Frame-Based Stereo-Electroencephalography Electrode Implantation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01196. [PMID: 38888309 DOI: 10.1227/ons.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Boltless implantation of stereo-electroencephalography electrode is a useful alternative especially when anchor bolt is not available such as in country with limited resources or is less appropriate such as placement in patients with thin skull or at the occiput area, despite some drawbacks including potential dislodgement. While the accuracy of implantation using anchor bolt is well-studied, data on boltless implantation remain scarce. This study aimed to reveal the accuracy, permissible error for actual placement of electrodes within the grey matter, and delayed electrode dislodgement in boltless implantation. METHODS A total of 120 electrodes were implanted in 15 patients using a Leksell Stereotactic G Frame with each electrode fixed on the scalp using sutures. Target point error was defined as the Euclidean distance between the planned target and the electrode tip on immediate postimplantation computed tomography. Similarly, delayed dislodgement was defined as the Euclidean distance between the electrode tips on immediate postimplantation computed tomography and delayed MRI. The factors affecting accuracy were evaluated using multiple linear regression. The permissible error was defined as the largest target point error that allows the maximum number of planned gray matter electrode contacts to be actually placed within the gray matter as intended. RESULTS The median (IQR) target point error was 2.6 (1.7-3.5) mm, and the permissible error was 3.2 mm. The delayed dislodgement, with a median (IQR) of 2.2 (1.4-3.3) mm, was dependent on temporal muscle penetration (P = 5.0 × 10-4), scalp thickness (P < 5.1 × 10-3), and insertion angle (P = 3.4 × 10-3). CONCLUSION Boltless implantation of stereo-electroencephalography electrode offers an accuracy comparable to those using anchor bolt. During the planning of boltless implantation, target points should be placed within 3.2 mm from the gray-white matter junction and a possible delayed dislodgement of 2.2 mm should be considered.
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Affiliation(s)
- Yuya Fujita
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Hui Ming Khoo
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Yuki Kimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takuto Emura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takamitsu Iwata
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takahiro Matsuhashi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Shimpei Miura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Naoki Tani
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Japan
- Epilepsy Center, Osaka University Hospital, Suita, Japan
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Permana GI, Morishita T, Tanaka H, Matsushita R, Kobayashi H, Abe H. Asymptomatic cable twisting in a patient with impending Twiddler syndrome detected during deep brain stimulation surgery for Parkinson's disease: A case report. Surg Neurol Int 2024; 15:86. [PMID: 38628532 PMCID: PMC11021058 DOI: 10.25259/sni_844_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024] Open
Abstract
Background Deep brain stimulation (DBS) has consistently demonstrated high efficacy and safety in patients with Parkinson's disease. Twiddler's syndrome is a rare occurrence of hardware failure in patients undergoing neuromodulation. We report here a case of subclinical cable twisting jeopardizing Twiddler's syndrome in a patient with Parkinson's disease who underwent DBS surgery targeting the globus pallidus internus (GPI). Case Description A 70-year-old woman with a 7-year history of Parkinson's disease refractory to medication was referred to our department for treatment of involuntary movements of the left hand and leg. She underwent right GPI DBS implantation. Left GPI DBS implantation was subsequently planned to manage resting tremors that developed in the right leg after the first surgery at around one year after the first surgery. During a routine check-up before the second surgery, we incidentally detected Twiddler's syndrome. The patient showed no neurological deficits in the left extremities, the same as before right GPI DBS. We performed left GPI DBS concomitantly with the revision of the implantable pulse generator and extension wire. Conclusion Twiddler's syndrome is a rare complication of DBS. Subclinical risk of cable twisting jeopardizing Twiddler's syndrome is rarely detected without clinical indications of hardware failure. Neurosurgeons should be cognizant of and regularly monitor the implanted device in case serious complications occur.
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Affiliation(s)
- Galih Indra Permana
- Department of Neurosurgery, Dr. Moewardi General Hospital, Surakarta, Indonesia
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Hideaki Tanaka
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Ryuji Matsushita
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
| | | | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Hospital, Fukuoka, Japan
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Baxter W, Salb K, Case M, Billstrom T. The Impact of Burr Hole Device and Lead Design on Deep Brain Stimulation Lead Stability in Benchtop and Ovine Models. Neuromodulation 2023; 26:1637-1645. [PMID: 35842368 DOI: 10.1016/j.neurom.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/29/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES A market-released deep brain stimulation (DBS) lead and burr hole device (BHD) have been used for more than ten years to provide stable DBS therapy using leads with four equally distributed cylindrical electrodes along the distal lead length. Newer directional leads cluster segmented electrodes at the center of the electrode array. This work tests the hypothesis that improved chronic translational and rotational stability through enhanced BHD design may ensure that these newer directional electrodes remain in a stable orientation near the stimulation target to maintain therapy and maximize opportunities to adjust therapy, if needed. MATERIALS AND METHODS A new DBS lead system (commercially available in the United States and termed "new" throughout the manuscript) has been developed, and a combination of bench testing (45 product samples tested) and chronic sheep studies (17 animals followed for 13.5 weeks on average) was conducted to test the hypothesis that design changes incorporated into the new DBS system further stabilize the position and orientation of a DBS lead tip compared with a legacy DBS system. RESULTS The new DBS system demonstrated a 55% relative improvement in chronic lead tip stability compared with the legacy DBS system with over a decade of clinical use. In a bench test, the new system required 79% more applied torque and 203% more lead body revolutions to rotate the lead in the BHD than the legacy system that was not designed to offer rotational stability. CONCLUSIONS These measurements quantitatively demonstrate that DBS system design can positively improve lead translational and rotational stability and show that system design is an important consideration for future product development.
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Yearley AG, Chua M, Horn A, Cosgrove GR, Rolston JD. Deep Brain Stimulation Lead Localization Variability Comparing Intraoperative MRI Versus Postoperative Computed Tomography. Oper Neurosurg (Hagerstown) 2023; 25:441-448. [PMID: 37584483 DOI: 10.1227/ons.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/02/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Commercially available lead localization software for deep brain stimulation (DBS) often relies on postoperative computed tomography (CT) scans to define electrode positions. When cases are performed with intraoperative MRI, another imaging set exists with which to perform these localizations. To compare DBS localization error between postoperative CT scans and intraoperative MRI. METHODS A retrospective cohort of patients who underwent MRI-guided placement of DBS electrodes using the ClearPoint platform was identified. Using Brainlab Elements, postoperative CT scans were coregistered to intraoperative magnetic resonance images visualizing the ClearPoint guidance sheaths and ceramic stylets. DBS electrodes were identified in CT scans using Brainlab's lead localization tool. Trajectory and vector errors were quantified between scans for each lead in each patient. RESULTS Eighty patients with a total of 157 implanted DBS electrodes were included. We observed mean trajectory and vector errors of 0.78 ± 0.44 mm (range 0.1-2.0 mm) and 1.57 ± 0.79 mm (range 0.2-4.2 mm), respectively, between postoperative CT and intraoperative MRI. There were 7 patients with CT scans collected at multiple time points. Trajectory error increased by 0.15 ± 0.42 mm ( P = .31), and vector error increased by 0.22 ± 0.53 mm ( P = .13) in the later scans. Across all scans, there was no significant association between trajectory ( P = .053) or vector ( P = .98) error and the date of CT acquisition. DBS electrodes targeting the subthalamic nucleus had significantly greater trajectory errors ( P = .02) than those targeting the globus pallidus pars internus nucleus. CONCLUSION Commercially available software produced largely concordant lead localizations when comparing intraoperative MRIs with postoperative CT scans, with trajectory errors on average <1 mm. CT scans tend to be more comparable with intraoperative MRI in the immediate postoperative period, with increased time intervals associated with a greater magnitude of error between modalities.
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Affiliation(s)
- Alexander G Yearley
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas Horn
- Department of Neurology, Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Orhurhu V, Hussain N, Karri J, Mariano ER, Abd-Elsayed A. Perioperative and anesthetic considerations for the management of neuromodulation systems. Reg Anesth Pain Med 2023; 48:327-336. [PMID: 37080581 DOI: 10.1136/rapm-2022-103660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/04/2022] [Indexed: 04/22/2023]
Abstract
The use of neuromodulation systems is increasing for the treatment of various pathologies ranging from movement disorders to urinary incontinence to chronic pain syndromes. While the type of neuromodulation devices varies, they are largely categorized as intracranial (eg, deep brain stimulation), neuraxial (eg, spinal cord stimulation, dorsal root ganglion stimulation, and intrathecal drug delivery systems), or peripheral (eg, sacral nerve stimulation and peripheral nerve stimulation) systems. Given the increasing prevalence of these systems in the overall population, it is important for anesthesiologists, surgeons, and the perioperative healthcare team to familiarize themselves with these systems and their unique perioperative considerations. In this review, we explore and highlight the various neuromodulation systems, their general perioperative considerations, and notable special circumstances for perioperative management.
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Affiliation(s)
- Vwaire Orhurhu
- Anesthesiology, University of Pittsburgh Medical Center, Williamsport, Pennsylvania, USA
- Pain Medicine, MVM Health, East Stroudsburg, Pennsylvania, USA
| | - Nasir Hussain
- Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jay Karri
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Divsion of Pain Medicine, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Andrews L, Keller SS, Osman-Farah J, Macerollo A. A structural magnetic resonance imaging review of clinical motor outcomes from deep brain stimulation in movement disorders. Brain Commun 2023; 5:fcad171. [PMID: 37304793 PMCID: PMC10257440 DOI: 10.1093/braincomms/fcad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/05/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
Patients with movement disorders treated by deep brain stimulation do not always achieve successful therapeutic alleviation of motor symptoms, even in cases where surgery is without complications. Magnetic resonance imaging (MRI) offers methods to investigate structural brain-related factors that may be predictive of clinical motor outcomes. This review aimed to identify features which have been associated with variability in clinical post-operative motor outcomes in patients with Parkinson's disease, dystonia, and essential tremor from structural MRI modalities. We performed a literature search for articles published between 1 January 2000 and 1 April 2022 and identified 5197 articles. Following screening through our inclusion criteria, we identified 60 total studies (39 = Parkinson's disease, 11 = dystonia syndromes and 10 = essential tremor). The review captured a range of structural MRI methods and analysis techniques used to identify factors related to clinical post-operative motor outcomes from deep brain stimulation. Morphometric markers, including volume and cortical thickness were commonly identified in studies focused on patients with Parkinson's disease and dystonia syndromes. Reduced metrics in basal ganglia, sensorimotor and frontal regions showed frequent associations with reduced motor outcomes. Increased structural connectivity to subcortical nuclei, sensorimotor and frontal regions was also associated with greater motor outcomes. In patients with tremor, increased structural connectivity to the cerebellum and cortical motor regions showed high prevalence across studies for greater clinical motor outcomes. In addition, we highlight conceptual issues for studies assessing clinical response with structural MRI and discuss future approaches towards optimizing individualized therapeutic benefits. Although quantitative MRI markers are in their infancy for clinical purposes in movement disorder treatments, structural features obtained from MRI offer the powerful potential to identify candidates who are more likely to benefit from deep brain stimulation and provide insight into the complexity of disorder pathophysiology.
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Affiliation(s)
- Luke Andrews
- The Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK
- Department of Neurology and Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L97LJ, UK
| | - Simon S Keller
- The Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK
| | - Jibril Osman-Farah
- Department of Neurology and Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L97LJ, UK
| | - Antonella Macerollo
- The Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L3 9TA, UK
- Department of Neurology and Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L97LJ, UK
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Alosaimi F, Dominguez-Paredes D, Knoben R, Almasabi F, Hescham S, Kozielski K, Temel Y, Jahanshahi A. Wireless stimulation of the subthalamic nucleus with nanoparticles modulates key monoaminergic systems similar to contemporary deep brain stimulation. Behav Brain Res 2023; 444:114363. [PMID: 36849047 DOI: 10.1016/j.bbr.2023.114363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/14/2022] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is commonly used to alleviate motor symptoms in several movement disorders. However, the procedure is invasive, and the technology has remained largely stagnant since its inception decades ago. Recently, we have shown that wireless nanoelectrodes may offer an alternative approach to conventional DBS. However, this method is still in its infancy, and more research is required to characterize its potential before it can be considered as an alternative to conventional DBS. OBJECTIVES Herein, we aimed to investigate the effect of stimulation via magnetoelectric nanoelectrodes on primary neurotransmitter systems that have implications for DBS in movement disorders. METHODS Mice were injected with either magnetoelectric nanoparticles (MENPs) or magnetostrictive nanoparticles (MSNPs, as a control) in the subthalamic nucleus (STN). Mice then underwent magnetic stimulation, and their motor behavior was assessed in the open field test. In addition, magnetic stimulation was applied before sacrifice and post-mortem brains were processed for immunohistochemistry (IHC) to assess the co-expression of c-Fos with either tyrosine hydroxylase (TH), tryptophan hydroxylase-2 (TPH2) or choline acetyltransferase (ChAT). RESULTS Stimulated animals covered longer distances in the open field test when compared to controls. Moreover, we found a significant increase in c-Fos expression in the motor cortex (MC) and paraventricular region of the thalamus (PV-thalamus) after magnetoelectric stimulation. Stimulated animals showed fewer TPH2/c-Fos double-labeled cells in the dorsal raphe nucleus (DRN), as well as TH/c-Fos double-labeled cells in the ventral tegmental area (VTA), but not in the substantia nigra pars compacta (SNc). There was no significant difference in the number of ChAT/ c-Fos double-labeled cells in the pedunculopontine nucleus (PPN). CONCLUSIONS Magnetoelectric DBS in mice enables selective modulation of deep brain areas and animal behavior. The measured behavioral responses are associated with changes in relevant neurotransmitter systems. These changes are somewhat similar to those observed in conventional DBS, suggesting that magnetoelectric DBS might be a suitable alternative.
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Affiliation(s)
- Faisal Alosaimi
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands; Department of Physiology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | - David Dominguez-Paredes
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Rick Knoben
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Faris Almasabi
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Sarah Hescham
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Kristen Kozielski
- School of Computation, Information and Technology, Technical University of Munich, Munich 80333, Germany
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Ali Jahanshahi
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands; Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
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Hou X, Mo Y, Zhu Z, Zhang H, Liu X, Zou Z, He X, Xue S, Li J, Li M, Zhang S. Technical Issues of Vim–PSA Double-Target DBS for Essential Tremor. Brain Sci 2023; 13:brainsci13040566. [PMID: 37190531 DOI: 10.3390/brainsci13040566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA) as the most common targets. The stimulation efficacy of ET with Vim–PSA double-target DBS has been reported. Herein, we aim to propose surgical techniques for Vim–PSA double-target DBS surgery. Methods: This study enrolled six patients with ET who underwent Vim–PSA double-target electrode implantation from October 2019 to May 2022. The targets were located and adjusted using coordinates and multimodality MRI images. A burr hole was accurately drilled in line with the electrode trajectory under the guidance of a stereotactic frame. Novel approaches were adopted during the electrode implantation process for pneumocephalus reduction, including “arachnoid piamater welding” and “water sealing”. Electrophysiological recording was used to identify the implantation sites of the electrodes. A 3D reconstruction model of electrodes and nuclei was established to facilitate programming. Results: The combination of coordinates and multimodality MRI images for target location and adjustment enabled the alignment of Vim and PSA. Postoperative CT scanning showed that the electrode was precisely implanted. Stereotactic guidance facilitated accurate burr hole drilling. “Arachnoid piamater welding” and “water sealing” were efficient in reducing pneumocephalus. Intraoperative electrophysiological verified the efficacy of Vim–PSA double-target DBS surgery. Conclusions: The methods for target location and adjustment, accurate drilling of the burr hole, reduction in pneumocephalus, and intraoperative electrophysiological verification are key issues in DBS surgery targeting both the Vim and PSA. This study may provide technical support for Vim–PSA DBS, especially for surgeons with less experience in functional neurosurgery.
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Rasiah NP, Maheshwary R, Kwon CS, Bloomstein JD, Girgis F. Complications of Deep Brain Stimulation for Parkinson Disease and Relationship between Micro-electrode tracks and hemorrhage: Systematic Review and Meta-Analysis. World Neurosurg 2023; 171:e8-e23. [PMID: 36244666 DOI: 10.1016/j.wneu.2022.10.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Deep brain stimulation is a common treatment for Parkinson's disease (PD). Despite strong efficacy in well-selected patients, complications can occur. Intraoperative micro-electrode recording (MER) can enhance efficacy by improving lead accuracy. However, there is controversy as to whether MER increases risk of hemorrhage. OBJECTIVES To provide a comprehensive systematic review and meta-analysis reporting complication rates from deep brain stimulation in PD. We also interrogate the association between hemorrhage and MER. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were implemented while querying the Pubmed, Embase, and Cochrane databases. All included studies were randomized controlled trials and prospective case series with 5 or more patients. Primary outcomes included rates of overall revision, infection, lead malposition, surgical site and wound complications, hardware-related complications, and seizure. The secondary outcome was the relationship between number of MER tracks and hemorrhage rate. RESULTS 262 articles with 21,261 patients were included in the analysis. Mean follow-up was 25.8 months (range 0-133). Complication rates were: revision 4.9%, infection 4.2%, lead malposition 3.3%, surgical site complications 2.8%, hemorrhage 2.4%, hardware-related complications 2.4%, and seizure 1.9%. While hemorrhage rate did not increase with single-track MER (odds ratio, 3.49; P = 0.29), there was a significant non-linear increase with each additional track. CONCLUSION Infection and lead malposition were the most common complications. Hemorrhage risk increases with more than one MER track. These results highlight the challenge of balancing surgical accuracy and perioperative risk.
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Affiliation(s)
- Neilen P Rasiah
- Department of Neurosurgery, Cumming School of Medicine, University of Calgary, Alberta, USA
| | - Romir Maheshwary
- Department of Neurosurgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Churl-Su Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua D Bloomstein
- Department of Neurosurgery, University of California Davis School of Medicine, Sacramento, California, USA
| | - Fady Girgis
- Department of Neurosurgery, Cumming School of Medicine, University of Calgary, Alberta, USA.
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Kim T, Kim HJ, Choi W, Lee YM, Pyo JH, Lee J, Kim J, Kim J, Kim JH, Kim C, Kim WJ. Deep brain stimulation by blood-brain-barrier-crossing piezoelectric nanoparticles generating current and nitric oxide under focused ultrasound. Nat Biomed Eng 2023; 7:149-163. [PMID: 36456857 DOI: 10.1038/s41551-022-00965-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/18/2022] [Indexed: 12/02/2022]
Abstract
Deep brain stimulation via implanted electrodes can alleviate neuronal disorders. However, its applicability is constrained by side effects resulting from the insertion of electrodes into the brain. Here, we show that systemically administered piezoelectric nanoparticles producing nitric oxide and generating direct current under high-intensity focused ultrasound can be used to stimulate deep tissue in the brain. The release of nitric oxide temporarily disrupted tight junctions in the blood-brain barrier, allowing for the accumulation of the nanoparticles into brain parenchyma, and the piezoelectrically induced output current stimulated the release of dopamine by dopaminergic neuron-like cells. In a mouse model of Parkinson's disease, the ultrasound-responsive nanoparticles alleviated the symptoms of the disease without causing overt toxicity. The strategy may inspire the development of other minimally invasive therapies for neurodegenerative diseases.
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Affiliation(s)
- Taejeong Kim
- Department of Chemistry, Postech-Catholic Biomedical Engineering Institute, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Hyun Jin Kim
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Wonseok Choi
- Department of Electrical Engineering and Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Yeong Mi Lee
- Department of Chemistry, Postech-Catholic Biomedical Engineering Institute, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Jung Hyun Pyo
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Junseok Lee
- Department of Chemistry, Postech-Catholic Biomedical Engineering Institute, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Jeesu Kim
- Department of Electrical Engineering and Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Jihoon Kim
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Joung-Hun Kim
- Department of Life Sciences, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Chulhong Kim
- Department of Electrical Engineering and Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea.,School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Won Jong Kim
- Department of Chemistry, Postech-Catholic Biomedical Engineering Institute, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea. .,School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea. .,OmniaMed Co., Ltd., Pohang, Republic of Korea.
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11
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Evaluation of Deep Brain Stimulation (DBS) Lead Biomechanical Interaction with Brain Tissue. Ann Biomed Eng 2023; 51:88-102. [PMID: 36094763 DOI: 10.1007/s10439-022-03044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 01/13/2023]
Abstract
The current study aims to examine the effect of material properties on implanted leads used for deep brain stimulation (DBS) using finite element (FE) analysis to investigate brain deformation around an implanted DBS lead in response to daily head accelerations. FE analysis was used to characterize the relative motion of the DBS lead in a suite of fifteen cases sampled from a previously derived kinematic envelope representative of everyday activities describing translational and rotational pulse shape, magnitude, and duration. Load curves were applied to the atlas-based brain model (ABM) with a scaled Haversine acceleration pulse in four directions of rotation: + X, - Y, + Y, and + Z. In addition to the fifteen sampled cases, six experimental cases taken from a previous literature review were also simulated for comparison. The current investigation found that there was very little difference in brain response for the DBS leads with two different material properties. In general, the brain and DBS lead experienced the greatest deformation during rotation about the Z axis for similar load cases. In conclusion, this study showed that there was no significant difference in implanted DBS lead deformation based on lead material properties.
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Nuzov NB, Bhusal B, Henry KR, Jiang F, Vu J, Rosenow JM, Pilitsis JG, Elahi B, Golestanirad L. Artifacts Can Be Deceiving: The Actual Location of Deep Brain Stimulation Electrodes Differs from the Artifact Seen on Magnetic Resonance Images. Stereotact Funct Neurosurg 2023; 101:47-59. [PMID: 36529124 PMCID: PMC9932848 DOI: 10.1159/000526877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/04/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a common treatment for a variety of neurological and psychiatric disorders. Recent studies have highlighted the role of neuroimaging in localizing the position of electrode contacts relative to target brain areas in order to optimize DBS programming. Among different imaging methods, postoperative magnetic resonance imaging (MRI) has been widely used for DBS electrode localization; however, the geometrical distortion induced by the lead limits its accuracy. In this work, we investigated to what degree the difference between the actual location of the lead's tip and the location of the tip estimated from the MRI artifact varies depending on the MRI sequence parameters such as acquisition plane and phase encoding direction, as well as the lead's extracranial configuration. Accordingly, an imaging technique to increase the accuracy of lead localization was devised and discussed. METHODS We designed and constructed an anthropomorphic phantom with an implanted DBS system following 18 clinically relevant configurations. The phantom was scanned at a Siemens 1.5 Tesla Aera scanner using a T1MPRAGE sequence optimized for clinical use and a T1TSE sequence optimized for research purposes. We varied slice acquisition plane and phase encoding direction and calculated the distance between the caudal tip of the DBS lead MRI artifact and the actual tip of the lead, as estimated from MRI reference markers. RESULTS Imaging parameters and lead configuration substantially altered the difference in the depth of the lead within its MRI artifact on the scale of several millimeters - with a difference as large as 4.99 mm. The actual tip of the DBS lead was found to be consistently more rostral than the tip estimated from the MR image artifact. The smallest difference between the tip of the DBS lead and the tip of the MRI artifact using the clinically relevant sequence (i.e., T1MPRAGE) was found with the sagittal acquisition plane and anterior-posterior phase encoding direction. DISCUSSION/CONCLUSION The actual tip of an implanted DBS lead is located up to several millimeters rostral to the tip of the lead's artifact on postoperative MR images. This distance depends on the MRI sequence parameters and the DBS system's extracranial trajectory. MRI parameters may be altered to improve this localization.
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Affiliation(s)
- Noa B Nuzov
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA, .,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA,
| | - Bhumi Bhusal
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kaylee R Henry
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Fuchang Jiang
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA
| | - Jasmine Vu
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Julie G Pilitsis
- Department of Neurosciences & Experimental Therapeutics, Albany Medical College, Albany, New York, USA
| | - Behzad Elahi
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Laleh Golestanirad
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois, USA.,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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13
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Miller KJ. A Stencil Instrument for Countersinking Deep Brain Stimulator Lead Anchoring Devices. World Neurosurg 2022; 167:98-101. [PMID: 36041724 DOI: 10.1016/j.wneu.2022.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/20/2022]
Abstract
Countersinking of deep brain stimulator lead anchoring devices reduces the risk of erosion through the scalp and improves cosmesis. This article describes a simple handheld stencil surgical instrument to assist in the countersinking process. It has 2 sides, each of which can be directly drilled through into the skull: one for making a full-thickness circular burr hole and the other for drilling a partial-thickness craniotomy to countersink the base ring of the anchoring device. This easy-to-use instrument speeds the surgery and ensures a tight contour around the base ring.
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Affiliation(s)
- Kai J Miller
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
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14
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Gelineau-Morel R, Kruer MC, Garris JF, Libdeh AA, Barbosa DAN, Coffman KA, Moon D, Barton C, Vera AZ, Bruce AB, Larsh T, Wu SW, Gilbert DL, O’Malley JA. Deep Brain Stimulation for Pediatric Dystonia: A Review of the Literature and Suggested Programming Algorithm. J Child Neurol 2022; 37:813-824. [PMID: 36053123 PMCID: PMC9912476 DOI: 10.1177/08830738221115248] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Deep brain stimulation (DBS) is an established intervention for use in pediatric movement disorders, especially dystonia. Although multiple publications have provided guidelines for deep brain stimulation patient selection and programming in adults, there are no evidence-based or consensus statements published for pediatrics. The result is lack of standardized care and underutilization of this effective treatment. To this end, we assembled a focus group of 13 pediatric movement disorder specialists and 1 neurosurgeon experienced in pediatric deep brain stimulation to review recent literature and current practices and propose a standardized approach to candidate selection, implantation target site selection, and programming algorithms. For pediatric dystonia, we provide algorithms for (1) programming for initial session and follow-up sessions, and (2) troubleshooting side effects encountered during programming. We discuss common side effects, how they present, and recommendations for management. This topical review serves as a resource for movement disorders specialists interested in using deep brain stimulation for pediatric dystonia.
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Affiliation(s)
- Rose Gelineau-Morel
- Division of Neurology, Department of Pediatrics, Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, Missouri, 64108
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Barrow Neurological Institute, Phoenix Children’s Hospital & University of Arizona College of Medicine - Phoenix, Phoenix, AZ, 85016
| | - Jordan F Garris
- Division of Pediatric Neurology, Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908−0394
| | - Amal Abu Libdeh
- Division of Pediatric Neurology, Department of Neurology, University of Virginia, PO Box 800394, Charlottesville, VA, 22908−0394
| | - Daniel A N Barbosa
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, Edwards Bldg, Stanford, CA, 94305
| | - Keith A Coffman
- Division of Neurology, Department of Pediatrics, Children’s Mercy Hospital, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, Missouri, 64108
| | - David Moon
- Department of Child Neurology, Division of Neurosciences, Helen DeVos Children’s Hospital, 100 Michigan St NE, Grand Rapids, MI 49503
| | - Christopher Barton
- Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky; Division of Child Neurology, Norton Children’s Medical Group, 231 E Chestnut St, Louisville, KY 40202
| | - Alonso Zea Vera
- Department of Neurology, Children’s National Hospital, 111 Michigan Ave NW, Washington, DC, 20010
| | - Adrienne B Bruce
- Division of Pediatric Neurology, Department of Pediatrics, Prisma Health, 200 Patewood Drive A350, Greenville, SC, USA 29615; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605
| | - Travis Larsh
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Location E4, Suite 110, Cincinnati, OH 45229
| | - Steve W Wu
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Location E4, Suite 110, Cincinnati, OH 45229
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, 3333 Burnet Ave, Location E4, Suite 110, Cincinnati, OH 45229
| | - Jennifer A O’Malley
- Department of Neurology, Division of Child Neurology, Stanford University School of Medicine, 750 Welch Road, Suite 317, Palo Alto, California, 94304
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15
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Ni R, Yuan Y, Yang L, Meng Q, Zhu Y, Zhong Y, Cao Z, Zhang S, Yao W, Lv D, Chen X, Chen X, Bu J. Novel Non-invasive Transcranial Electrical Stimulation for Parkinson's Disease. Front Aging Neurosci 2022; 14:880897. [PMID: 35493922 PMCID: PMC9039727 DOI: 10.3389/fnagi.2022.880897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022] Open
Abstract
Conventional transcranial electrical stimulation (tES) is a non-invasive method to modulate brain activity and has been extensively used in the treatment of Parkinson's disease (PD). Despite promising prospects, the efficacy of conventional tES in PD treatment is highly variable across different studies. Therefore, many have tried to optimize tES for an improved therapeutic efficacy by developing novel tES intervention strategies. Until now, these novel clinical interventions have not been discussed or reviewed in the context of PD therapy. In this review, we focused on the efficacy of these novel strategies in PD mitigation, classified them into three categories based on their distinct technical approach to circumvent conventional tES problems. The first category has novel stimulation modes to target different modulating mechanisms, expanding the rang of stimulation choices hence enabling the ability to modulate complex brain circuit or functional networks. The second category applies tES as a supplementary intervention for PD hence amplifies neurological or behavioral improvements. Lastly, the closed loop tES stimulation can provide self-adaptive individualized stimulation, which enables a more specialized intervention. In summary, these novel tES have validated potential in both alleviating PD symptoms and improving understanding of the pathophysiological mechanisms of PD. However, to assure wide clinical used of tES therapy for PD patients, further large-scale trials are required.
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Affiliation(s)
- Rui Ni
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Ye Yuan
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Li Yang
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Qiujian Meng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Ying Zhu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Yiya Zhong
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Zhenqian Cao
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Shengzhao Zhang
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
| | - Wenjun Yao
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Daping Lv
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Chen
- Department of Neurology, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Junjie Bu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, China
- Department of Neurosurgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
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16
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Molle ZK, Slotty P, Vesper J. Surgical management of "Twiddler syndrome" in patients with deep brain stimulation: a technical note and review of the literature. Acta Neurochir (Wien) 2022; 164:1183-1186. [PMID: 35212800 PMCID: PMC8967733 DOI: 10.1007/s00701-022-05135-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Abstract
Background The Twiddler syndrome (TS) describes a situation in which the implanted impulse generator (IPG) rotates several times around its own axis in the subcutaneous pocket. This can lead to severe mechanical damage of the leads and extensions and to dislocations. Method Hereby, we report on a technique for revision surgery in patients diagnosed with Twiddler syndrome after undergoing previous deep brain stimulation (DBS) surgery. For revision surgery, the TYRX ™ Absorbable Antibacterial Envelope was used. Conclusion The TS can be treated well with the envelope TYRX ™ Absorbable Antibacterial Envelope TYRX ™. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-022-05135-8.
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Affiliation(s)
- Z Krause Molle
- Dept. of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich Heine University, Düsseldorf, Germany
| | - P Slotty
- Dept. of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich Heine University, Düsseldorf, Germany
| | - J Vesper
- Dept. of Functional Neurosurgery and Stereotaxy, Neurosurgical Clinic, Heinrich Heine University, Düsseldorf, Germany.
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17
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Yabe A, Okada M, Hara ES, Torii Y, Matsumoto T. Self-adhering implantable device of titanium: Enhanced soft-tissue adhesion by sandblast pretreatment. Colloids Surf B Biointerfaces 2021; 211:112283. [PMID: 34922156 DOI: 10.1016/j.colsurfb.2021.112283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023]
Abstract
Self-adhering implantable devices, which can be immobilized inside the bodies without suturing nor organic glues, made of metallic biomaterials would be optimal devices for preventing device-related complications such as device migration after implantation. We reported previously that acid-treated commercially-pure titanium (CpTi) adhered directly and immediately on hydrous non-keratinized soft tissues. Herein, we investigated the influence of sandblasting as pretreatment for acid-treated CpTi to increase its soft tissue adhesiveness. First, the effects of sandblasting conditions (i.e., pressure, distance and time) were investigated in terms of the sandblasted surface area and the degree of deformation (i.e., internal stress formation) of CpTi films. The effect of the sandblasting on the immediate soft tissue adhesion of acid-treated CpTi was investigated using an ex vivo shear adhesion test with mouse dermal tissues. The optimal sandblasting pretreatment remarkably improved the soft tissue adhesion strength of acid-treated CpTi (102 ± 19 kPa) compared with the non-sandblasted counterparts (41 ± 2 kPa). Finally, the CpTi adhesive was applied for immobilizing a near field communication (NFC) device in vivo, and was shown to have strong immediate adhesion to muscle fascia.
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Affiliation(s)
- Atsushi Yabe
- Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Department of Comprehensive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Masahiro Okada
- Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
| | - Emilio Satoshi Hara
- Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yasuhiro Torii
- Department of Comprehensive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; Comprehensive Dental Clinic, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Takuya Matsumoto
- Department of Biomaterials, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
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18
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Yalaz M, Deuschl G, Sohail Noor M, Butz M, Schnitzler A, Helmers AK, Höft M. Determining the rotational orientation of directional deep brain stimulation electrodes using magnetoencephalography. J Neural Eng 2021; 18. [PMID: 34598173 DOI: 10.1088/1741-2552/ac2c4d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
Objective.The aim of the present study was to evaluate the effect of different electrode configurations on the accuracy of determining the rotational orientation of the directional deep brain stimulation (DBS) electrode with our previously published magnetoencephalography (MEG)-based method.Approach.A directional DBS electrode, along with its implantable pulse generator, was integrated into a head phantom and placed within the MEG sensor array. Predefined bipolar electrode configurations, based on activation of different directional and omnidirectional contacts of the electrode, were set to generate a defined magnetic field during stimulation. This magnetic field was then measured with MEG. Finite element modeling and model fitting approach were used to calculate electrode orientation.Main results.The accuracy of electrode orientation detection depended on the electrode configuration: the vertical configuration (activation of two directional contacts arranged one above the other) achieved an average accuracy of only about 41 ∘. The diagonal configuration (activation of the electrode tip and a single directional contact at the next higher level of the electrode) achieved an accuracy of 13∘, while the horizontal electrode configuration (activation of two adjacent directional contacts at the same electrode level) achieved the best accuracy of 6∘. The accuracy of orientation detection of the DBS electrode depends on the change in spatial distribution of the magnetic field with the rotation of the electrode along its own axis. In the vertical configuration, rotation of the electrode has a small effect on the magnetic field distribution, while in the diagonal or horizontal configuration, electrode rotation has a significant effect on the magnetic field distribution.Significance.Our work suggests that in order to determine rotational orientation of a DBS electrode using MEG, horizontal configuration should be used as it provides the most accurate results compared to other possible configurations.
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Affiliation(s)
- Mevlüt Yalaz
- Chair of Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany
| | - M Sohail Noor
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
| | - Markus Butz
- Institute of Clinical Neuroscience and Medical iPsychology, Medical Faculty of HHU, 40225 Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical iPsychology, Medical Faculty of HHU, 40225 Düsseldorf, Germany
| | - Ann-Kristin Helmers
- Department of Neurosurgery, Christian-Albrechts-Universität zu Kiel, 24105 Kiel, Germany
| | - Michael Höft
- Chair of Microwave Engineering, Christian-Albrechts-Universität zu Kiel, 24143 Kiel, Germany
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Liu X, Xu Y, Bergman H, Li S, Wang W. A systematic review of Twiddler's syndrome: a hardware-related complication of deep brain stimulation. Neurosurg Rev 2021; 45:951-963. [PMID: 34491478 DOI: 10.1007/s10143-021-01636-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/28/2021] [Indexed: 02/05/2023]
Abstract
Twiddler's syndrome (TS) is a hardware-related complication of deep brain stimulation which has not been well documented and is probably underreported. The objective of this study is to comprehensively describe TS by systematically reviewing the related literature. The methods include selecting the eligible studies based on the inclusion and exclusion criteria. Data about studies and TS were collected. A descriptive statistical analysis of the extracted data was performed. We found 18 eligible studies describing 23 patients with TS. The mean age of the 23 patients was 61.4 ± 15.9 years (range, 16-79 years.). The percentage of TS in the female population was 91.3% (females: 21/23). The incidence of postoperative TS was 1.4% (6 out of 437) per patient and 1.1% (8 out of 709) per extension wire. The mean time to clinical presentation was 9.9 ± 10.3 months (range, 0.5-36 months). Nineteen of the twenty-three patients presented with a rebound of previous symptoms. Twelve of the twenty-three patients had high impedance at the postoperative checkup of the DBS system. A plain X-ray indicated twisted extension wires in almost all these patients. All patients meeting the definition of postoperative device-related TS underwent revision surgery. TS is more prevalent in females. Based on the typical clinical symptoms (rebound of the previous symptoms, high impedance, and X-ray demonstration), the differential diagnosis can often be straightforward. TS should thus be taken into consideration when attempting to explain or rule out hardware malfunction. The timely recognition and proper revision of TS can prevent further serious damage.
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Affiliation(s)
- Xiaowei Liu
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Yangyang Xu
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel.,Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - Siyu Li
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China
| | - Wei Wang
- Department of Neurosurgery, West China School of Medicine, West China Hospital, Sichuan University, Guoxue Lane No. 37, Chengdu, 610041, Sichuan, China.
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20
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Morrison MA, Lee AT, Martin AJ, Dietiker C, Brown EG, Wang DD. DBS targeting for essential tremor using intersectional dentato-rubro-thalamic tractography and direct proton density visualization of the VIM: technical note on 2 cases. J Neurosurg 2021; 135:806-814. [PMID: 33450737 DOI: 10.3171/2020.8.jns201378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Direct visualization of the ventral intermediate nucleus (VIM) of the thalamus on standard MRI sequences remains elusive. Therefore, deep brain stimulation (DBS) surgery for essential tremor (ET) indirectly targets the VIM using atlas-derived consensus coordinates and requires awake intraoperative testing to confirm clinical benefits. The objective of this study was to evaluate the utility of proton density (PD)-weighted MRI and tractography of the intersecting dentato-rubro-thalamic tract (DRTT) for direct "intersectional" targeting of the VIM in ET. METHODS DBS targets were selected by identifying the VIM on PD-weighted images relative to the DRTT in 2 patients with ET. Tremor reduction was confirmed with intraoperative clinical testing. Intended target coordinates based on the direct intersectional targeting technique were compared with consensus coordinates obtained with indirect targeting. Pre- and postoperative tremor scores were assessed using the Fahn-Tolosa-Marin tremor rating scale (TRS). RESULTS Planned DBS coordinates based on direct versus indirect targeting of the VIM differed in both the anteroposterior (range 0 to 2.3) and lateral (range -0.7 to 1) directions. For 1 patient, indirect targeting-without PD-weighted visualization of the VIM and DRTT-would have likely resulted in suboptimal electrode placement within the VIM. At the 3-month follow-up, both patients demonstrated significant improvement in tremor symptoms subjectively and according to the TRS (case 1: 68%, case 2: 72%). CONCLUSIONS Direct intersectional targeting of the VIM using PD-weighted imaging and DRTT tractography is a feasible method for DBS placement in patients with ET. These advanced targeting techniques can supplement awake intraoperative testing or be used independently in asleep cases to improve surgical efficiency and confidence.
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Affiliation(s)
- Melanie A Morrison
- 2Department of Radiology & Biomedical Imaging, University of California, San Francisco; and
| | - Anthony T Lee
- 1Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco
| | - Alastair J Martin
- 2Department of Radiology & Biomedical Imaging, University of California, San Francisco; and
| | - Cameron Dietiker
- 3Department of Neurology, Movement Disorders and Neuromodulation Center, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Ethan G Brown
- 3Department of Neurology, Movement Disorders and Neuromodulation Center, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Doris D Wang
- 1Department of Neurological Surgery, Weill Institute for Neurosciences, University of California, San Francisco
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21
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Holanda VM, Eisinger RS, Almeida L, Tsuboi T, Wang H, Okun MS, Deeb W, Patterson A, Wagle Shukla A, Lobo Lopes J, Foote KD. Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience. Front Neurol 2021; 12:679918. [PMID: 34456844 PMCID: PMC8387620 DOI: 10.3389/fneur.2021.679918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/05/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting. Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies. Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (β = 0.09, p < 0.0001), posteriorly [slope (β) = 0.04, p < 0.05], and dorsally (β = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (β = 0.06, p = 0.053). Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.
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Affiliation(s)
- Vanessa M Holanda
- Department of Neurosurgery, Center of Neurology and Neurosurgery Associates (NeuroCENNA), Beneficencia Portuguesa of São Paulo Hospital, São Paulo, Brazil
| | - Robert Stephen Eisinger
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Takashi Tsuboi
- Department of Neurology, Nagoya University, Nagoya, Japan
| | - Huimin Wang
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Wissam Deeb
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Addie Patterson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Janine Lobo Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Kelly Douglas Foote
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
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22
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Rau A, Urbach H, Coenen VA, Egger K, Reinacher PC. Deep brain stimulation electrodes may rotate after implantation-an animal study. Neurosurg Rev 2021; 44:2349-2353. [PMID: 33125566 PMCID: PMC8338867 DOI: 10.1007/s10143-020-01429-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/03/2022]
Abstract
Directional deep brain stimulation (dDBS) electrodes allow to steer the electrical field in a specific direction. When implanted with torque, they may rotate for a certain time after implantation. The aim of this study was to evaluate whether and to which degree leads rotate in the first 24 h after implantation using a sheep brain model. dDBS electrodes were implanted in 14 sheep heads and 3D rotational fluoroscopy (3D-RF) scans were acquired to visualize the orientation of the electrode leads. Electrode leads were clockwise rotated just above the burr holes (180° n = 6, 360° n = 6, 2 controls) and 3D-RF scans were again acquired after 3, 6, 13, 17, and 24 h, respectively. One hundred eighty degree rotated electrodes showed an initial rotation of 83.5° (range: 35.4°-128.3°) and a rotation of 114.0° (range: 57°-162°) after 24 h. With 360° torsion, mean initial rotation was 201° (range: 3.3°-321.4°) and mean rotation after 24 h 215.7° (range 31.9°-334.7°), respectively. Direct postoperative imaging may not be accurate for determining the rotation of dDBS electrodes if torque is present.
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Affiliation(s)
- Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
| | - H Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - V A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - K Egger
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - P C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology, Aachen, Germany
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23
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Malinova V, Jaskólski DJ, Wójcik R, Mielke D, Rohde V. Frameless x-ray-based lead re-implantation after partial hardware removal of deep brain stimulation system with preservation of intracerebral trajectories. Acta Neurochir (Wien) 2021; 163:1873-1878. [PMID: 33754181 PMCID: PMC8195963 DOI: 10.1007/s00701-021-04807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
Background Deep brain stimulation (DBS) is an established treatment for patients with medical refractory movement disorders with continuously increasing use also in other neurological and psychiatric diseases. Early and late complications can lead to revision surgeries with partial or complete DBS-system removal. In this study, we aimed to report on our experience with a frameless x-ray-based lead re-implantation technique after partial hardware removal or dysfunction of DBS-system, allowing the preservation of intracerebral trajectories. Methods We describe a surgical procedure with complete implant removal due to infection except for the intracranial part of the electrode and with non-stereotactic electrode re-implantation. A retrospective analysis of a patient series treated using this technique was performed and the surgical outcome was evaluated including radiological and clinical parameters. Results A total of 8 DBS-patients with lead re-implantation using the frameless x-ray-based method were enrolled in the study. A revision of 14 leads was performed, whereof a successful lead re-implantation could be achieved without any problems in 10 leads (71%). In two patients (one patient with dystonia and one patient with tremor), the procedure was not successful, so we placed both leads frame-based stereotactically. Conclusions The described x-ray-based technique allows a reliable frameless electrode re-implantation after infection and electrode dysfunction and might represent an efficient alternative to frame-based procedures for lead revision making the preservation of intracerebral trajectories possible.
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Affiliation(s)
- Vesna Malinova
- Department of Neurosurgery, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Dariusz J Jaskólski
- Department of Neurosurgery and Neurooncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Rafal Wójcik
- Department of Neurosurgery and Neurooncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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24
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Chapelle F, Manciet L, Pereira B, Sontheimer A, Coste J, El Ouadih Y, Cimpeanu R, Gouot D, Lapusta Y, Claise B, Sautou V, Bouattour Y, Marques A, Wohrer A, Lemaire JJ. Early Deformation of Deep Brain Stimulation Electrodes Following Surgical Implantation: Intracranial, Brain, and Electrode Mechanics. Front Bioeng Biotechnol 2021; 9:657875. [PMID: 34178958 PMCID: PMC8226181 DOI: 10.3389/fbioe.2021.657875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/29/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Although deep brain stimulation is nowadays performed worldwide, the biomechanical aspects of electrode implantation received little attention, mainly as physicians focused on the medical aspects, such as the optimal indication of the surgical procedure, the positive and adverse effects, and the long-term follow-up. We aimed to describe electrode deformations and brain shift immediately after implantation, as it may highlight our comprehension of intracranial and intracerebral mechanics. Materials and Methods Sixty electrodes of 30 patients suffering from severe symptoms of Parkinson’s disease and essential tremor were studied. They consisted of 30 non-directional electrodes and 30 directional electrodes, implanted 42 times in the subthalamus and 18 times in the ventrolateral thalamus. We computed the x (transversal), y (anteroposterior), z (depth), torsion, and curvature deformations, along the electrodes from the entrance point in the braincase. The electrodes were modelized from the immediate postoperative CT scan using automatic voxel thresholding segmentation, manual subtraction of artifacts, and automatic skeletonization. The deformation parameters were computed from the curve of electrodes using a third-order polynomial regression. We studied these deformations according to the type of electrodes, the clinical parameters, the surgical-related accuracy, the brain shift, the hemisphere and three tissue layers, the gyration layer, the white matter stem layer, and the deep brain layer (type I error set at 5%). Results We found that the implanted first hemisphere coupled to the brain shift and the stiffness of the type of electrode impacted on the electrode deformations. The deformations were also different according to the tissue layers, to the electrode type, and to the first-hemisphere-brain-shift effect. Conclusion Our findings provide information on the intracranial and brain biomechanics and should help further developments on intracerebral electrode design and surgical issues.
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Affiliation(s)
- Frédéric Chapelle
- Sigma Clermont, Clermont Auvergne Institut National Polytechnique, Clermont-Ferrand, France.,Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France
| | - Lucie Manciet
- Sigma Clermont, Clermont Auvergne Institut National Polytechnique, Clermont-Ferrand, France.,Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la Recherche Clinique et de l'Innovation, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Sontheimer
- Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France.,Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérôme Coste
- Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France.,Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Youssef El Ouadih
- Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France.,Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Ruxandra Cimpeanu
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Dimitri Gouot
- Sigma Clermont, Clermont Auvergne Institut National Polytechnique, Clermont-Ferrand, France.,Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France
| | - Yuri Lapusta
- Sigma Clermont, Clermont Auvergne Institut National Polytechnique, Clermont-Ferrand, France.,Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France
| | - Béatrice Claise
- Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France.,Service de radiologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valérie Sautou
- Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Yassine Bouattour
- Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Ana Marques
- Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France.,Service de neurologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Adrien Wohrer
- Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Université Clermont Auvergne, Centre National de la Recherche Scientifique, Clermont Auvergne Institut National Polytechnique, Institut Pascal, Clermont-Ferrand, France.,Service de Neurochirurgie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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25
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Muacevic A, Adler JR, Novakovic E, Huynh H, Jones K, Gendreau JL, Mammis A, Abraham ME. Characterizing Complications of Deep Brain Stimulation Devices for the Treatment of Parkinsonian Symptoms Without Tremor: A Federal MAUDE Database Analysis. Cureus 2021; 13:e15539. [PMID: 34277165 PMCID: PMC8269991 DOI: 10.7759/cureus.15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is a modality of treatment for medication refractory Parkinson's disease (PD) in patients with debilitating motor symptoms. While potentially life-changing for individuals with Parkinson's disease, characterization of adverse events for these DBS devices have not yet been systematically organized. Therefore, the goal of this study was to characterize reported complications of DBS devices reported to the Food & Drug Administration over the last 10 years. Methods The Manufacturer and User Facility Device Experience (MAUDE) database was utilized to retrieve entries reported under "Stimulator, Electrical, Implanted, For Parkinsonian Symptoms" between July 31, 2010 and August 1, 2020. After removing duplicate entries, each unique adverse event reported was sorted into complication categories based on the entries' provided narrative description. A final tabulation of complications was generated. Results The search query revealed 221 unique adverse events. The most common DBS devices were the Vercise Gevia, Vercise Cartesia and Vercise PC produced by Boston Scientific (Brian Walker, Boston Scientific, Marlborough, MA, USA). The most commonly reported complications were infection (16.2%) follow by lead migrations (8.6%). Other common causes of complications were circuit-related impedance (6.5%), cerebral bleeds (6.3%), device failure (6.3%) and device-related trauma (4.5%). Over a third (40%) of all devices reported with adverse events required returning to the operating room for explant or revision. Conclusion The most common complications of DBS systems are infections followed by lead migrations. Further research is needed to minimize infection rates associated with DBS systems and to reduce intrinsic device malfunctions for patients in the future.
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Affiliation(s)
| | | | - Ena Novakovic
- Neurological Surgery, Mercer University School of Medicine, Savannah, USA
| | - Huey Huynh
- Neurological Surgery, Mercer University School of Medicine, Macon, USA
| | - Keri Jones
- Graduate Medical Education, Eisenhower Army Medical Center, Augusta, USA
| | | | - Antonios Mammis
- Neurological Surgery, New York University School of Medicine, New York, USA
| | - Mickey E Abraham
- Neurological Surgery, University of California San Diego, San Diego, USA
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26
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Single-Stage Deep Brain Stimulator Placement for Movement Disorders: A Case Series. Brain Sci 2021; 11:brainsci11050592. [PMID: 34063572 PMCID: PMC8147611 DOI: 10.3390/brainsci11050592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
With more than two decades of experience and thousands of patients treated worldwide, deep brain stimulation (DBS) has established itself as an efficacious and common surgical treatment for movement disorders. However, a substantial majority of patients in the United States still undergo multiple, “staged” surgeries to implant a DBS system. Despite several reports suggesting no significant difference in complications or efficacy between staged and non-staged approaches, the continued use of staging implies surgeons harbor continued reservations about placing all portions of a system during the index procedure. In an effort to eliminate multiple surgeries and simplify patient care, DBS implantations at our institution have been routinely performed in a single surgery over the past four years. Patients who underwent placement of new DBS systems at our institution from January 2016 to June 2019 were identified and their records were reviewed. Revision surgeries were excluded. Total operative time, length of stay and rates of surgical site infections, lead fracture or migration, and other complications were evaluated. This series expands the body of evidence suggesting placement of a complete DBS system during a single procedure appears to be an efficacious and well-tolerated option.
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27
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Philipp LR, Matias CM, Thalheimer S, Mehta SH, Sharan A, Wu C. Robot-Assisted Stereotaxy Reduces Target Error: A Meta-Analysis and Meta-Regression of 6056 Trajectories. Neurosurgery 2021; 88:222-233. [PMID: 33045739 DOI: 10.1093/neuros/nyaa428] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The pursuit of improved accuracy for localization and electrode implantation in deep brain stimulation (DBS) and stereoelectroencephalography (sEEG) has fostered an abundance of disparate surgical/stereotactic practices. Specific practices/technologies directly modify implantation accuracy; however, no study has described their respective influence in multivariable context. OBJECTIVE To synthesize the known literature to statistically quantify factors affecting implantation accuracy. METHODS A systematic review and meta-analysis was conducted to determine the inverse-variance weighted pooled mean target error (MTE) of implanted electrodes among patients undergoing DBS or sEEG. MTE was defined as Euclidean distance between planned and final electrode tip. Meta-regression identified moderators of MTE in a multivariable-adjusted model. RESULTS A total of 37 eligible studies were identified from a search return of 2,901 potential articles (2002-2018) - 27 DBS and 10 sEEG. Random-effects pooled MTE = 1.91 mm (95% CI: 1.7-2.1) for DBS and 2.34 mm (95% CI: 2.1-2.6) for sEEG. Meta-regression identified study year, robot use, frame/frameless technique, and intraoperative electrophysiologic testing (iEPT) as significant multivariable-adjusted moderators of MTE (P < .0001, R2 = 0.63). Study year was associated with a 0.92-mm MTE reduction over the 16-yr study period (P = .0035), and robot use with a 0.79-mm decrease (P = .0019). Frameless technique was associated with a mean 0.50-mm (95% CI: 0.17-0.84) increase, and iEPT use with a 0.45-mm (95% CI: 0.10-0.80) increase in MTE. Registration method, imaging type, intraoperative imaging, target, and demographics were not significantly associated with MTE on multivariable analysis. CONCLUSION Robot assistance for stereotactic electrode implantation is independently associated with improved accuracy and reduced target error. This remains true regardless of other procedural factors, including frame-based vs frameless technique.
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Affiliation(s)
- Lucas R Philipp
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Caio M Matias
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Sara Thalheimer
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Shyle H Mehta
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Ashwini Sharan
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
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28
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Quirin T, Féry C, Vogel D, Vergne C, Sarracanie M, Salameh N, Madec M, Hemm S, Hébrard L, Pascal J. Towards Tracking of Deep Brain Stimulation Electrodes Using an Integrated Magnetometer. SENSORS (BASEL, SWITZERLAND) 2021; 21:2670. [PMID: 33920125 PMCID: PMC8068940 DOI: 10.3390/s21082670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022]
Abstract
This paper presents a tracking system using magnetometers, possibly integrable in a deep brain stimulation (DBS) electrode. DBS is a treatment for movement disorders where the position of the implant is of prime importance. Positioning challenges during the surgery could be addressed thanks to a magnetic tracking. The system proposed in this paper, complementary to existing procedures, has been designed to bridge preoperative clinical imaging with DBS surgery, allowing the surgeon to increase his/her control on the implantation trajectory. Here the magnetic source required for tracking consists of three coils, and is experimentally mapped. This mapping has been performed with an in-house three-dimensional magnetic camera. The system demonstrates how magnetometers integrated directly at the tip of a DBS electrode, might improve treatment by monitoring the position during and after the surgery. The three-dimensional operation without line of sight has been demonstrated using a reference obtained with magnetic resonance imaging (MRI) of a simplified brain model. We observed experimentally a mean absolute error of 1.35 mm and an Euclidean error of 3.07 mm. Several areas of improvement to target errors below 1 mm are also discussed.
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Affiliation(s)
- Thomas Quirin
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Corentin Féry
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
| | - Dorian Vogel
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Department of Biomedical Engineering, Linköping University, 581 83 Linköping, Sweden
| | - Céline Vergne
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Mathieu Sarracanie
- Center for Adaptable MRI Technology, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (M.S.); (N.S.)
| | - Najat Salameh
- Center for Adaptable MRI Technology, Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland; (M.S.); (N.S.)
| | - Morgan Madec
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Simone Hemm
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
- Department of Biomedical Engineering, Linköping University, 581 83 Linköping, Sweden
| | - Luc Hébrard
- Icube laboratory, UMR 7357 (University of Strasbourg/CNRS), 67412 Illkirch, France; (M.M.); (L.H.)
| | - Joris Pascal
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland (FHNW), 4132 Muttenz, Switzerland; (C.F.); (D.V.); (C.V.); (S.H.); (J.P.)
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29
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Kim HJ, Jeon B. Arching deep brain stimulation in dystonia types. J Neural Transm (Vienna) 2021; 128:539-547. [PMID: 33740122 DOI: 10.1007/s00702-021-02304-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/11/2020] [Indexed: 12/29/2022]
Abstract
Although medical treatment including botulinum toxic injection is the first-line treatment for dystonia, response is insufficient in many patients. In these patients, deep brain stimulation (DBS) can provide significant clinical improvement. Mounting evidence indicates that DBS is an effective and safe treatment for dystonia, especially for idiopathic and inherited isolated generalized/segmental dystonia, including DYT-TOR1A. Other inherited dystonia and acquired dystonia also respond to DBS to varying degrees. For Meige syndrome (craniofacial dystonia), other focal dystonia, and some rare inherited dystonia, further evidences are still needed to evaluate the role of DBS. Because short disease duration at DBS surgery and absence of fixed musculoskeletal deformity are associated with better outcome, DBS should be considered as early as possible when indicated after careful evaluation including genetic work-up. This review will focus on the factors to be considered in DBS for patients with dystonia and the outcome of DBS in the different types of dystonia.
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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van den Munckhof P, Bot M, Schuurman PR. Targeting of the Subthalamic Nucleus in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation Surgery. Neurol Ther 2021; 10:61-73. [PMID: 33565018 PMCID: PMC8140007 DOI: 10.1007/s40120-021-00233-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
Precise stereotactic targeting of the dorsolateral motor part of the subthalamic nucleus (STN) is paramount for maximizing clinical effectiveness and preventing side effects of deep brain stimulation (DBS) in patients with advanced Parkinson's disease. With recent developments in magnetic resonance imaging (MRI) techniques, direct targeting of the dorsolateral part of the STN is now feasible, together with visualization of the motor fibers in the nearby internal capsule. However, clinically relevant discrepancies were reported when comparing STN borders on MRI to electrophysiological STN borders during microelectrode recordings (MER). Also, one should take into account the possibility of a 3D inaccuracy of up to 2 mm of the applied stereotactic technique. Pneumocephalus and image fusion errors may further increase implantation inaccuracy. Even when implantation has been successful, suboptimal lead anchoring on the skull may cause lead migration during follow-up. Meticulous pre- and intraoperative imaging is therefore indispensable, and so is postoperative imaging when the effects of DBS deteriorate during follow-up. Thus far, most DBS centers employ MRI targeting, multichannel MER, and awake test stimulation in STN surgery, but randomized trials comparing surgery under local versus general anesthesia and additional studies comparing MER-STN borders to high-field MRI-STN may change this clinical practice. Further developments in imaging protocols and improvements in image fusion processes are needed to optimize placement of DBS leads in the dorsolateral motor part of the STN in Parkinson's disease.
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Affiliation(s)
- Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands.
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
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Yalaz M, Noor S, McIntyre C, Butz M, Schnitzler A, Deuschl G, Höft M. DBS electrode localization and rotational orientation detection using SQUID-based magnetoencephalography. J Neural Eng 2021; 18. [PMID: 33503598 DOI: 10.1088/1741-2552/abe099] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/27/2021] [Indexed: 11/12/2022]
Abstract
The aim of the present study was to investigate the accuracy of localization and rotational orientation detection of a directional deep brain stimulation (DBS) electrode using a state-of-the-art magnetoencephalography (MEG) scanner. A directional DBS electrode along with its stimulator was integrated into a head phantom and placed inside the MEG sensor array. The electrode was comprised of six directional and two omnidirectional contacts. Measurements were performed while stimulating with different contacts and parameters in the phantom. Finite element modeling and fitting approach were used to compute electrode position and orientation. The electrode was localized with a mean accuracy of 2.2 mm while orientation was determined with a mean accuracy of 11°. The limitation in detection accuracy was due to the lower measurement precision of the MEG system. Considering an ideal measurement condition, these values represent the lower bound of accuracy that can be achieved in patients. However, a future magnetic measuring system with higher precision will potentially detect location and orientation of a DBS electrode with an even increased accuracy.
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Affiliation(s)
- Mevlüt Yalaz
- Christian-Albrechts-Universität zu Kiel, Kaiserstrasse 2, Kiel, Schleswig-Holstein, 24143, GERMANY
| | - Sohail Noor
- Case Western Reserve University, 2103 Cornell Road, Cleveland, Ohio, 44106, UNITED STATES
| | - Cameron McIntyre
- Case Western Reserve University, 2103 Cornell Road, Cleveland, Ohio, 44106, UNITED STATES
| | - Markus Butz
- Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf, Nordrhein-Westfalen, 40225, GERMANY
| | - Alfons Schnitzler
- Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, Düsseldorf, Nordrhein-Westfalen, 40225, GERMANY
| | - Gunther Deuschl
- Department of Neurology, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Straße 3, Kiel, Schleswig-Holstein, 24105, GERMANY
| | - Michael Höft
- Christian-Albrechts-Universität zu Kiel, Kaiserstrasse 2, Kiel, Schleswig-Holstein, 24143, GERMANY
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Doshi PK, Rai N, Das D. Surgical and Hardware Complications of Deep Brain Stimulation-A Single Surgeon Experience of 519 Cases Over 20 Years. Neuromodulation 2021; 25:895-903. [PMID: 33496063 DOI: 10.1111/ner.13360] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) surgery has its own set of risks and complications. This study from a single center and a single surgeon analyzes various risk factors for complications and tries to establish if there is a learning curve effect in minimizing the complications. MATERIALS AND METHODS A retrospective analysis of 519 patients (1024 leads) who underwent DBS surgery and 232 patients who underwent implantable pulse generator replacement (IPG), by a single surgeon, between the years 1999 and 2019 was performed. Perioperative and hardware related complications were evaluated. RESULTS The follow-up period ranged from six months to 20 years. Surgery-related complications occurred in 46 (8.9%) cases which included confusion in 31 (5.98%), intracerebral hemorrhage in 7 (1.3%), vasovagal attack in 3 (0.58%), respiratory distress in 2 (0.38%), postoperative aggressiveness in 1 (0.19%), and blepharospasm in 2 (0.38%) patients. Complications related to the DBS hardware were found in 35 cases, including erosion and infection in 22 (2.95%), inaccurate lead placement or migration in 6 (0.6%) lead fracture/extension wire failure in 2 (0.26%), IPG malfunction in 2 (0.26%), and hardware discomfort in 3 (0.4%) cases. In three patients, one lead was repositioned. In cases of infection, 87% of patients had either partial or complete removal of hardware. There was no mortality. The complications were analyzed for every 100 DBS procedures. There was a significant drop in the percentage of complications in from 23% in the first 100 cases to 7% in the last 100 cases (p < 0.0001). CONCLUSION Confusion remains the most frequent operative and perioperative complication. Erosion and infection of the surgical site represents the most frequent hardware complication. DBS surgery is safe and the complication rates are acceptably low. The complication rate also decreases with cumulative years of experience, demonstrating a learning curve effect.
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Affiliation(s)
- Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Neha Rai
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Deepak Das
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
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Göransson N, Johansson JD, Wårdell K, Zsigmond P. Postoperative Lead Movement after Deep Brain Stimulation Surgery and the Change of Stimulation Volume. Stereotact Funct Neurosurg 2020; 99:221-229. [PMID: 33326986 DOI: 10.1159/000511406] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lead movement after deep brain stimulation may occur and influence the affected volume of stimulation. The aim of the study was to investigate differences in lead position between the day after surgery and approximately 1 month postoperatively and also simulate the electric field (EF) around the active contacts in order to investigate the impact of displacement on affected volume. METHODS Twenty-three patients with movement disorders underwent deep brain stimulation surgery (37 leads). Computed tomography at the 2 time points were co-fused respectively with the stereotactic images in Surgiplan. The coordinates (x, y, and z) of the lead tips were compared between the 2 dates. Eleven of these patients were selected for the EF simulation in Comsol Multiphysics. Postoperative changes of EF spread in the tissue due to conductivity changes in perielectrode space and due to displacement were evaluated by calculating the coverage coefficient and the Sørensen-Dice coefficient. RESULTS There was a significant displacement (mean ± SD) on the left lead: x (0.44 ± 0.72, p < 0.01), y (0.64 ± 0.54, p < 0.001), and z (0.62 ± 0.71, p < 0.001). On the right lead, corresponding values were: x (-0.11 ± 0.61, ns), y (0.71 ± 0.54, p < 0.001), and z (0.49 ± 0.81, p < 0.05). The anchoring technique was a statistically significant variable associated with displacement. No correlation was found between bilateral (n = 14) versus unilateral deep brain stimulation, gender (n = 17 male), age <60 years (n = 8), and calculated air volume. The simulated stimulation volume was reduced after 1 month because of the perielectrode space. When considering perielectrode space and displacement, the volumes calculated the day after surgery and approximately 1 month later were partly overlapped. CONCLUSION The left lead tip displayed a tendency to move lateral, anterior, and inferior and the right a tendency to move anterior and inferior. The anchoring technique was associated to displacement. New brain territory was affected due to the displacement despite considering the reduced stimulated volume after 1 month. Postoperative changes in perielectrode space and small lead movements are reasons for delaying programming to 4 weeks following surgery.
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Affiliation(s)
- Nathanael Göransson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden, .,Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,
| | - Johannes D Johansson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Peter Zsigmond
- Department of Neurosurgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Martino A, Darbin O, Templeton K, Dees D, Lammle M, Torres T, Williams D, Naritoku D. Physical Plasticity of the Brain and Deep Brain Stimulation Lead: Evolution in the First Post-operative Week. Front Surg 2020; 7:55. [PMID: 33062638 PMCID: PMC7477286 DOI: 10.3389/fsurg.2020.00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Deep brain stimulation (DBS) is a therapy for movement disorders and psychiatric conditions. In the peri-operative period, brain shift occurs as the consequence of events related to the brain surgery which results in post-operative lead deformation. Objective: To quantify post-operative 3-dimensional DBS lead deformation after implantation. Methods: In 13 patients who had DBS lead implantation, we performed preoperative magnetic resonance imaging (MRI), preoperative computed tomography (CT) scans after placement of fiducial markers, and post-operative CT scans immediately, 24-48 h, and 7 days after implantation. The MRI scans were used to define brain orientation and merged with CT scans. Lead deviation was determined relative to a theoretical linear lead path defined by the skull entry and target lead tip points. Results: In the sagittal plane, we distinguished an initial period after surgery (<48 h) characterized by a deviation of the lead toward the rostral direction and a late period (over 1 week) characterized by a lead deviation toward the caudal direction. In the coronal plane, there was higher probability of lead deviation in the lateral than medial direction. During 7 days after implantation, there was net movement of the center of the lead anteriorly, and the half of the lead close to the entry point moved medially. These deviations appeared normative since all patients included in this study had benefits from DBS therapy with total power of charged comparable to those described in literature. Conclusion: DBS lead deviation occurs during 7 days after implantation. The range of deviation described in this study was not associated to adverse clinical effects and may be considered normative. Future multicenter studies would be helpful to define guide lines on DBS lead deformation and its contribution to clinical outcome.
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Affiliation(s)
- Anthony Martino
- Department of Neurosurgery, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Olivier Darbin
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Kelsey Templeton
- Department of Neurosurgery, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Daniel Dees
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Markus Lammle
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, United States.,Department of Radiology, Tulane University, New Orleans, LA, United States
| | - Tatiana Torres
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Dakota Williams
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Dean Naritoku
- Department of Neurology, College of Medicine, University of South Alabama, Mobile, AL, United States
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Ågren R, Bartek J, Johansson A, Blomstedt P, Fytagoridis A. Pulse Width and Implantable Pulse Generator Longevity in Pallidal Deep Brain Stimulation for Dystonia: A Population-Based Comparative Effectiveness Study. Stereotact Funct Neurosurg 2020; 98:331-336. [PMID: 32668433 DOI: 10.1159/000508794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A wide range of pulse widths (PWs) has been used in globus pallidus internus (GPi) deep brain stimulation (DBS) for dystonia. However, no specific PW has demonstrated clinical superiority, and the paradigm may differ among DBS centers. OBJECTIVE To investigate how different paradigms of PWs in GPi DBS for dystonia affect implantable pulse generator (IPG) longevities and energy consumption. METHODS Thirty-nine patients with dystonia treated with bilateral GPi DBS at 2 Swedish DBS centers from 2005 to 2015 were included. Different PW paradigms were used at the 2 centers, 60-90 µs (short PWs) and 450 µs (long PW), respectively. The frequency of IPG replacements, pulse effective voltage (PEV), IPG model, pre-/postoperative imaging, and clinical outcome based on the clinical global impression (CGI) scale were collected from the medical charts and compared between the 2 groups. RESULTS The average IPG longevity was extended for the short PWs (1,129 ± 50 days) compared to the long PW (925 ± 32 days; χ2 = 12.31, p = 0.0005, log-rank test). IPG longevity correlated inversely with PEV (Pearson's r = -0.667, p < 0.0001). IPG longevities did not differ between Kinetra® and Activa® PC in the short (p = 0.319) or long PW group (p = 0.858). Electrode distances to the central sensorimotor region of the GPi did not differ between the short or long PW groups (p = 0.595). Pre- and postoperative CGI did not differ between groups. CONCLUSIONS Short PWs were associated with decreased energy consumption and increased IPG longevity. These effects were not dependent on the IPG model or the anatomic location of the electrodes. PWs did not correlate with symptom severities or clinical outcomes. The results suggest that the use of short PWs might be more energy efficient and could therefore be preferred initially when programming patients with GPi DBS for dystonia.
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Affiliation(s)
- Richard Ågren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
| | - Jiri Bartek
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Rigshospitalet, Copenhagen, Sweden
| | - Anders Johansson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Patric Blomstedt
- Department of Pharmacology and Clinical Neuroscience, Unit of Functional and Stereotactic Neurosurgery, Umeå University, Umeå, Sweden
| | - Anders Fytagoridis
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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Tsuboi T, Cif L, Coubes P, Ostrem JL, Romero DA, Miyagi Y, Lozano AM, De Vloo P, Haq I, Meng F, Sharma N, Ozelius LJ, Wagle Shukla A, Cauraugh JH, Foote KD, Okun MS. Secondary Worsening Following DYT1 Dystonia Deep Brain Stimulation: A Multi-country Cohort. Front Hum Neurosci 2020; 14:242. [PMID: 32670041 PMCID: PMC7330126 DOI: 10.3389/fnhum.2020.00242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Objective: To reveal clinical characteristics of suboptimal responses to deep brain stimulation (DBS) in a multi-country DYT1 dystonia cohort. Methods: In this multi-country multi-center retrospective study, we analyzed the clinical data of DYT1 patients who experienced suboptimal responses to DBS defined as <30% improvement in dystonia scales at the last follow-up compared with baseline. We used a literature-driven historical cohort of 112 DYT1 patients for comparison. Results: Approximately 8% of our study cohort (11 out of 132) experienced suboptimal responses to DBS. Compared with the historical cohort, the multi-country cohort with suboptimal responses had a significantly younger age at onset (mean, 7.0 vs. 8.4 years; p = 0.025) and younger age at DBS (mean, 12.0 vs. 18.6 years; p = 0.019). Additionally, cranial involvement was more common in the multi-country cohort (before DBS, 64% vs. 45%, p = 0.074; before or after DBS, 91% vs. 47%, p = 0.001). Mean motor improvement at the last follow-up from baseline were 0% and 66% for the multi-country and historical cohorts, respectively. All 11 patients of the multi-country cohort had generalization of dystonia within 2.5 years after disease onset. All patients experienced dystonia improvement of >30% postoperatively; however, secondary worsening of dystonia commenced between 6 months and 3 years following DBS. The improvement at the last follow-up was less than 30% despite optimally-placed leads, a trial of multiple programming settings, and additional DBS surgeries in all patients. The on-/off-stimulation comparison at the long-term follow-up demonstrated beneficial effects of DBS despite missing the threshold of 30% improvement over baseline. Conclusion: Approximately 8% of patients represent a more aggressive phenotype of DYT1 dystonia characterized by younger age at onset, faster disease progression, and cranial involvement, which seems to be associated with long-term suboptimal responses to DBS (e.g., secondary worsening). This information could be useful for both clinicians and patients in clinical decision making and patient counseling before and following DBS implantations. Patients with this phenotype may have different neuroplasticity, neurogenetics, or possibly distinct neurophysiology.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Laura Cif
- Department of Neurology, University Hospital Montpellier, Montpellier, France
| | - Philippe Coubes
- Department of Neurosurgery, University Hospital Montpellier, Montpellier, France
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Danilo A Romero
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Yasushi Miyagi
- Department of Stereotactic and Functional Neurosurgery, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital Krembil Neuroscience Center, Toronto, ON, Canada.,Department of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Philippe De Vloo
- Department of Neurosurgery, University of Toronto, Toronto, ON, Canada.,Department of Neurosurgery, KU Leuven, Leuven, Belgium
| | - Ihtsham Haq
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Fangang Meng
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nutan Sharma
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Laurie J Ozelius
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - James H Cauraugh
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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Niederer J, Patriat R, Rosenberg O, Palnitkar T, Darrow D, Park MC, Schrock L, Eberly LE, Harel N. Factors Influencing Electrode Position and Bending of the Proximal Lead in Deep Brain Stimulation for Movement Disorders. Stereotact Funct Neurosurg 2020; 98:300-312. [PMID: 32485728 DOI: 10.1159/000507029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The introduction of intracranial air (ICA) during deep brain stimulation (DBS) surgery is thought to have a negative influence on targeting and clinical outcomes. OBJECTIVE To investigate ICA volumes following surgery and other patient-specific factors as potential variables influencing translocation of the DBS electrode and proximal lead bowing. METHODS High-resolution postoperative computed tomography scans (≤1.0 mm resolution in all directions) within 24 h following DBS surgery and 4-6 weeks of follow-up were acquired. A total of 50 DBS leads in 33 patients were available for analysis. DBS leads included Abbott/St. Jude Medical InfinityTM, Boston Scientific VerciseTM, and Medtronic 3389TM. RESULTS Both ICA volume and anatomical target were significantly associated with measures of DBS electrode translocation. ICA volume and DBS lead model were found to be significant predictors of proximal lead bowing. Measures of proximal lead bowing and translocation along the electrode trajectory for the Medtronic 3389TM DBS lead were significantly larger than measures for the Abbott/St. Jude Medical InfinityTM and Boston Scientific VerciseTM DBS leads. CONCLUSION The association between ICA volume and translocation of the DBS electrode is small in magnitude and not clinically relevant for DBS cases within a normal range of postoperative subdural air volumes. Differences in proximal lead bowing observed between DBS leads may reflect hardware engineering subtleties in the construction of DBS lead models.
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Affiliation(s)
- Jacob Niederer
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rémi Patriat
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Oren Rosenberg
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tara Palnitkar
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren Schrock
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lynn E Eberly
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Noam Harel
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA, .,Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA,
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Merola A, Romagnolo A, Krishna V, Pallavaram S, Carcieri S, Goetz S, Mandybur G, Duker AP, Dalm B, Rolston JD, Fasano A, Verhagen L. Current Directions in Deep Brain Stimulation for Parkinson's Disease-Directing Current to Maximize Clinical Benefit. Neurol Ther 2020; 9:25-41. [PMID: 32157562 PMCID: PMC7229063 DOI: 10.1007/s40120-020-00181-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 12/19/2022] Open
Abstract
Several single-center studies and one large multicenter clinical trial demonstrated that directional deep brain stimulation (DBS) could optimize the volume of tissue activated (VTA) based on the individual placement of the lead in relation to the target. The ability to generate axially asymmetric fields of stimulation translates into a broader therapeutic window (TW) compared to conventional DBS. However, changing the shape and surface of stimulating electrodes (directional segmented vs. conventional ring-shaped) also demands a revision of the programming strategies employed for DBS programming. Model-based approaches have been used to predict the shape of the VTA, which can be visualized on standardized neuroimaging atlases or individual magnetic resonance imaging. While potentially useful for optimizing clinical care, these systems remain limited by factors such as patient-specific anatomical variability, postsurgical lead migrations, and inability to account for individual contact impedances and orientation of the systems of fibers surrounding the electrode. Alternative programming tools based on the functional assessment of stimulation-induced clinical benefits and side effects allow one to collect and analyze data from each electrode of the DBS system and provide an action plan of ranked alternatives for therapeutic settings based on the selection of optimal directional contacts. Overall, an increasing amount of data supports the use of directional DBS. It is conceivable that the use of directionality may reduce the need for complex programming paradigms such as bipolar configurations, frequency or pulse width modulation, or interleaving. At a minimum, stimulation through directional electrodes can be considered as another tool to improve the benefit/side effect ratio. At a maximum, directionality may become the preferred way to program because of its larger TW and lower energy consumption.
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Affiliation(s)
- Aristide Merola
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Vibhor Krishna
- Department of Neurosurgery, Ohio State Wexner Medical Center, Columbus, OH, USA
| | | | | | - Steven Goetz
- Medtronic PLC Brain Modulation, Minneapolis, MN, USA
| | | | - Andrew P Duker
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Brian Dalm
- Department of Neurosurgery, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Leo Verhagen
- Department of Neurological Sciences, Movement Disorder Section, Rush University, Chicago, IL, USA
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Macerollo A, Zrinzo L, Akram H, Foltynie T, Limousin P. Subthalamic nucleus deep brain stimulation for Parkinson’s disease: current trends and future directions. Expert Rev Med Devices 2020; 17:1063-1074. [DOI: 10.1080/17434440.2020.1747433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Antonella Macerollo
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- School of Psychology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Harith Akram
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
| | - Patricia Limousin
- Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK
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Obidin N, Tasnim F, Dagdeviren C. The Future of Neuroimplantable Devices: A Materials Science and Regulatory Perspective. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1901482. [PMID: 31206827 DOI: 10.1002/adma.201901482] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/12/2019] [Indexed: 06/09/2023]
Abstract
The past two decades have seen unprecedented progress in the development of novel materials, form factors, and functionalities in neuroimplantable technologies, including electrocorticography (ECoG) systems, multielectrode arrays (MEAs), Stentrode, and deep brain probes. The key considerations for the development of such devices intended for acute implantation and chronic use, from the perspective of biocompatible hybrid materials incorporation, conformable device design, implantation procedures, and mechanical and biological risk factors, are highlighted. These topics are connected with the role that the U.S. Food and Drug Administration (FDA) plays in its regulation of neuroimplantable technologies based on the above parameters. Existing neuroimplantable devices and efforts to improve their materials and implantation protocols are first discussed in detail. The effects of device implantation with regards to biocompatibility and brain heterogeneity are then explored. Topics examined include brain-specific risk factors, such as bacterial infection, tissue scarring, inflammation, and vasculature damage, as well as efforts to manage these dangers through emerging hybrid, bioelectronic device architectures. The current challenges of gaining clinical approval by the FDA-in particular, with regards to biological, mechanical, and materials risk factors-are summarized. The available regulatory pathways to accelerate next-generation neuroimplantable devices to market are then discussed.
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Affiliation(s)
- Nikita Obidin
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Farita Tasnim
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Canan Dagdeviren
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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Nonaka M, Morishita T, Yamada K, Fujioka S, Higuchi MA, Tsuboi Y, Abe H, Inoue T. Surgical management of adverse events associated with deep brain stimulation: A single-center experience. SAGE Open Med 2020; 8:2050312120913458. [PMID: 32231782 PMCID: PMC7082866 DOI: 10.1177/2050312120913458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives: Deep brain stimulation is widely used to treat movement disorders and selected neuropsychiatric disorders. Despite the fact, the surgical methods vary among centers. In this study, we aimed to evaluate our own surgical complications and how we performed surgical troubleshooting. Methods: A retrospective chart review was performed to evaluate the clinical data of patients who underwent deep brain stimulation surgery and deep brain stimulation–related procedures at our center between October 2014 and September 2019. We reviewed surgical complications and how surgical troubleshooting was performed, regardless of where the patient underwent the initial surgery. Results: A total of 92 deep brain stimulation lead implantation and 43 implantable pulse generator replacement procedures were performed. Among the 92 lead implantation procedures, there were two intracranial lead replacement surgeries and one deep brain stimulation lead implantation into the globus pallidus to add to existing deep brain stimulation leads in the bilateral subthalamic nuclei. Wound revision for superficial infection of the implantable pulse generator site was performed in four patients. There was neither intracerebral hemorrhage nor severe hardware infection in our series of procedures. An adaptor (extension cable) replacement was performed due to lead fracture resulting from a head trauma in two cases. Conclusion: We report our experience of surgical management of adverse events associated with deep brain stimulation therapy with clinical vignettes. Deep brain stimulation surgery is a safe and effective procedure when performed by a trained neurosurgeon. It is important for clinicians to be aware that there are troubles that are potentially manageable with optimal surgical treatment.
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Affiliation(s)
- Masani Nonaka
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazumichi Yamada
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Abstract
Surgery in Parkinson disease is effective for a select group of patients when optimal medical management is not sufficient. Functional neurosurgery can be used as either a salvage therapy in patients with disabling symptoms or to maintain quality of life and independence before progression to severe disability in high-functioning patients. With recent technological advancements in imaging and targeting as well as novel neuromodulation paradigms, there are numerous options for targeted brain lesions and deep brain stimulation. Surgical decision making and postoperative management in Parkinson disease therefore often requires a multidisciplinary team effort with neurology, neurosurgery, neuropsychology, and psychiatry.
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Affiliation(s)
- Kyle T Mitchell
- Duke University Movement Disorders Center, DUMC 3333, 932 Morreene Road, Durham, NC 27705, USA.
| | - Jill L Ostrem
- UCSF Movement Disorders and Neuromodulation Center, 1635 Divisadero Street Suite 520, Box 1838, San Francisco, CA 94115, USA
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Luo M, Larson PS, Martin AJ, Miga MI. Accounting for Deformation in Deep Brain Stimulation Surgery With Models: Comparison to Interventional Magnetic Resonance Imaging. IEEE Trans Biomed Eng 2020; 67:2934-2944. [PMID: 32078527 DOI: 10.1109/tbme.2020.2974102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The efficacy of deep brain stimulation (DBS) depends on electrode placement accuracy, which can be jeopardized by brain shift due to burr hole and dura opening during surgery. Brain shift violates assumed rigid alignment between preoperative image and intraoperative anatomy, negatively impacting therapy. OBJECTIVE This study presents a deformation-atlas biomechanical model-based approach to address shift. METHODS Six patients, who underwent interventional magnetic resonance (iMR) image-guided DBS burr hole surgery, were studied. A patient-specific model was employed under varying surgical conditions, generating a collection of possible intraoperative shift estimations or a 'deformation atlas.' An inverse problem was driven by sparse measurements derived from iMR to determine an optimal fit of solutions of the atlas. This fit was then used to obtain a volumetric deformation field, which was utilized to update preoperative MR and estimate shift at surgical target region localized on iMR. Model performance was examined by quantitatively comparing intraoperative subsurface measurements to their model-predicted counterparts, and qualitatively comparing iMR, preoperative MR, and model updated MR. A nonrigid image registration was introduced as a comparator. RESULTS Model-based approach reduced general parenchyma shift from 8.2 ± 2.2 to 2.7 ± 1.1 mm (∼66.8% correction), and produced updated MR with better agreement to iMR than that of preoperative MR. The average model estimated shift at target region was 1.2 mm. CONCLUSIONS This study demonstrates the feasibility of a model-based shift correction strategy in DBS surgery with only sparse data. SIGNIFICANCE The developed strategy has the potential to complement and/or enhance current clinical approaches in addressing shift.
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Tsuboi T, Jabarkheel Z, Zeilman PR, Barabas MJ, Foote KD, Okun MS, Wagle Shukla A. Longitudinal follow-up with VIM thalamic deep brain stimulation for dystonic or essential tremor. Neurology 2020; 94:e1073-e1084. [PMID: 32047071 DOI: 10.1212/wnl.0000000000008875] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To assess longitudinal tremor outcomes with ventral intermediate nucleus deep brain stimulation (VIM DBS) in patients with dystonic tremor (DT) and to compare with DBS outcomes in essential tremor (ET). METHODS We retrospectively investigated VIM DBS outcomes for 163 patients followed at our center diagnosed with either DT or ET. The Fahn-Tolosa-Marin tremor rating scale (TRS) was used to assess change in tremor and activities of daily living (ADL) at 6 months, 1 year, 2-3 years, 4-5 years, and ≥6 years after surgery. RESULTS Twenty-six patients with DT and 97 patients with ET were analyzed. Compared to preoperative baseline, there were significant improvements in TRS motor up to 4-5 years (52.2%; p = 0.032) but this did not reach statistical significance at ≥6 years (46.0%, p = 0.063) in DT, which was comparable to the outcomes in ET. While the improvements in the upper extremity tremor, head tremor, and axial tremor were also comparable between DT and ET throughout the follow-up, the ADL improvements in DT were lost at 2-3 years follow-up. CONCLUSION Overall, tremor control with VIM DBS in DT and ET was comparable and remained sustained at long term likely related to intervention at the final common node in the pathologic tremor network. However, the long-term ADL improvements in DT were not sustained, possibly due to inadequate control of concomitant dystonia symptoms. These findings from a large cohort of DT indicate that VIM targeting is reasonable if the tremor is considerably more disabling than the dystonic features. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that VIM DBS improves tremor in patients with DT or ET.
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Affiliation(s)
- Takashi Tsuboi
- From the Department of Neurology, Norman Fixel Institute for Neurological Diseases (T.T., Z.J., P.R.Z., M.J.B., M.S.O., A.W.S.), and Department of Neurosurgery (K.D.F.), University of Florida, Gainesville, FL
| | - Zakia Jabarkheel
- From the Department of Neurology, Norman Fixel Institute for Neurological Diseases (T.T., Z.J., P.R.Z., M.J.B., M.S.O., A.W.S.), and Department of Neurosurgery (K.D.F.), University of Florida, Gainesville, FL
| | - Pamela R Zeilman
- From the Department of Neurology, Norman Fixel Institute for Neurological Diseases (T.T., Z.J., P.R.Z., M.J.B., M.S.O., A.W.S.), and Department of Neurosurgery (K.D.F.), University of Florida, Gainesville, FL
| | - Matthew J Barabas
- From the Department of Neurology, Norman Fixel Institute for Neurological Diseases (T.T., Z.J., P.R.Z., M.J.B., M.S.O., A.W.S.), and Department of Neurosurgery (K.D.F.), University of Florida, Gainesville, FL
| | - Kelly D Foote
- From the Department of Neurology, Norman Fixel Institute for Neurological Diseases (T.T., Z.J., P.R.Z., M.J.B., M.S.O., A.W.S.), and Department of Neurosurgery (K.D.F.), University of Florida, Gainesville, FL
| | - Michael S Okun
- From the Department of Neurology, Norman Fixel Institute for Neurological Diseases (T.T., Z.J., P.R.Z., M.J.B., M.S.O., A.W.S.), and Department of Neurosurgery (K.D.F.), University of Florida, Gainesville, FL
| | - Aparna Wagle Shukla
- From the Department of Neurology, Norman Fixel Institute for Neurological Diseases (T.T., Z.J., P.R.Z., M.J.B., M.S.O., A.W.S.), and Department of Neurosurgery (K.D.F.), University of Florida, Gainesville, FL
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Tsuboi T, Wong JK, Almeida L, Hess CW, Wagle Shukla A, Foote KD, Okun MS, Ramirez-Zamora A. A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia. J Neurol 2020; 267:1278-1290. [DOI: 10.1007/s00415-020-09703-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/24/2022]
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Bullard AJ, Hutchison BC, Lee J, Chestek CA, Patil PG. Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays. Neuromodulation 2019; 23:411-426. [DOI: 10.1111/ner.13069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/05/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Autumn J. Bullard
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | | | - Jiseon Lee
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Electrical Engineering and Computer Science University of Michigan Ann Arbor MI USA
| | - Parag G. Patil
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Neurosurgery University of Michigan Medical School Ann Arbor MI USA
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Wang T, Pan Y, Zhang C, Zhan S, Sun B, Li D. Lead fixation in deep brain stimulation: comparison of three lead anchoring devices in China. BMC Surg 2019; 19:92. [PMID: 31307448 PMCID: PMC6631761 DOI: 10.1186/s12893-019-0558-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 07/08/2019] [Indexed: 11/15/2022] Open
Abstract
Background The accuracy of deep brain stimulation (DBS) depends on precise electrode positioning, which has been pursued for ideal treatment outcomes. As a critical component of DBS, the fixation performance of lead anchoring devices has been widely studied. Possible reasons for lead shift were analyzed in the current study and we further provided effective solutions to reduce potential manual errors. Methods Seventy-nine patients who received DBS implantations at the Ruijin Hospital from April to November 2017 were retrospectively reviewed. Intraoperative lead shifts were measured by C-arm fluoroscopy. Lead adjustment counts were recorded and compared among three lead fixation devices: Stimloc™ (Medtronic, Minneapolis, MN, USA), TouchLoc (SceneRay, Suzhou, China), and the traditional lead anchoring device. Results Mean (± SD) distances of lead shifts were 0.29 ± 2.42 mm in Stimloc devices, 0.43 ± 0.55 mm in TouchLoc devices, and 1.52 ± 1.05 mm in traditional devices (p < 0.0001). Average numbers of adjustments in this series were 0.3 ± 0.5 in Stimloc devices, 0.3 ± 1.3 in TouchLoc devices, and 1.1 ± 1.0 in traditional devices (p = 0.0001). Pairwise comparisons among the three devices (TouchLoc vs. Stimloc: p = 0.273; TouchLoc vs. Traditional: p = 0.0001; Stimloc vs. traditional: p < 0.0001) suggested significant differences, which were mainly attributed to the traditional devices. Conclusions Three lead anchoring devices have been compared for their performance in the accuracy of lead fixation, in which the newly designed lead fixation devices have presented its advantages to the traditional one. In addition to the application of the Stimloc and TouchLoc devices, verification by C-arm fluoroscopy should be performed to provide an intuitive view of the depth deviation of electrode position during DBS electrode implantation.
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Affiliation(s)
- Tao Wang
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, No.197, Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yixin Pan
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, No.197, Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, No.197, Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, No.197, Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, No.197, Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, No.197, Ruijin Second Road, Huangpu District, Shanghai, 200025, China.
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Gulino M, Kim D, Pané S, Santos SD, Pêgo AP. Tissue Response to Neural Implants: The Use of Model Systems Toward New Design Solutions of Implantable Microelectrodes. Front Neurosci 2019; 13:689. [PMID: 31333407 PMCID: PMC6624471 DOI: 10.3389/fnins.2019.00689] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/18/2019] [Indexed: 01/28/2023] Open
Abstract
The development of implantable neuroelectrodes is advancing rapidly as these tools are becoming increasingly ubiquitous in clinical practice, especially for the treatment of traumatic and neurodegenerative disorders. Electrodes have been exploited in a wide number of neural interface devices, such as deep brain stimulation, which is one of the most successful therapies with proven efficacy in the treatment of diseases like Parkinson or epilepsy. However, one of the main caveats related to the clinical application of electrodes is the nervous tissue response at the injury site, characterized by a cascade of inflammatory events, which culminate in chronic inflammation, and, in turn, result in the failure of the implant over extended periods of time. To overcome current limitations of the most widespread macroelectrode based systems, new design strategies and the development of innovative materials with superior biocompatibility characteristics are currently being investigated. This review describes the current state of the art of in vitro, ex vivo, and in vivo models available for the study of neural tissue response to implantable microelectrodes. We particularly highlight new models with increased complexity that closely mimic in vivo scenarios and that can serve as promising alternatives to animal studies for investigation of microelectrodes in neural tissues. Additionally, we also express our view on the impact of the progress in the field of neural tissue engineering on neural implant research.
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Affiliation(s)
- Maurizio Gulino
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB – Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- FEUP – Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
| | - Donghoon Kim
- Multi-Scale Robotics Lab (MSRL), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Salvador Pané
- Multi-Scale Robotics Lab (MSRL), Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Zurich, Switzerland
| | - Sofia Duque Santos
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB – Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Ana Paula Pêgo
- i3S – Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- INEB – Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
- FEUP – Faculdade de Engenharia, Universidade do Porto, Porto, Portugal
- ICBAS – Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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3-D printing for constructing the burr hole ring of lead fixation device in deep brain stimulation. J Clin Neurosci 2018; 58:229-233. [DOI: 10.1016/j.jocn.2018.10.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 10/14/2018] [Indexed: 11/19/2022]
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Milchenko M, Snyder AZ, Campbell MC, Dowling JL, Rich KM, Brier LM, Perlmutter JS, Norris SA. ESM-CT: a precise method for localization of DBS electrodes in CT images. J Neurosci Methods 2018; 308:366-376. [PMID: 30201271 PMCID: PMC6205293 DOI: 10.1016/j.jneumeth.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus produces variable effects in Parkinson disease. Variation may result from different electrode positions relative to target. Thus, precise electrode localization is crucial when investigating DBS effects. NEW METHOD We developed a semi-automated method, Electrode Shaft Modeling in CT images (ESM-CT) to reconstruct DBS lead trajectories and contact locations. We evaluated methodological sensitivity to operator-dependent steps, robustness to image resampling, and test-retest replicability. ESM-CT was applied in 56 patients to study electrode position change (and relation to time between scans, postoperative subdural air volume, and head tilt during acquisition) between images acquired immediately post-implantation (DBS-CT) and months later (DEL-CT). RESULTS Electrode tip localization was robust to image resampling and replicable to within ∼ 0.2 mm on test-retest comparisons. Systematic electrode displacement occurred rostral-ventral-lateral between DBS-CT and DEL-CT scans. Head angle was a major explanatory factor (p < 0.001,Pearson's r = 0.46, both sides) and volume of subdural air weakly predicted electrode displacement (p = 0.02,r = 0.29:p = 0.1,r = 0.25 for left:right). Modeled shaft curvature was slightly greater in DEL-CT. Magnitude of displacement and degree of curvature were independent of elapsed time between scans. COMPARISON WITH EXISTING METHODS Comparison of ESM-CT against two existing methods revealed systematic differences in one coordinate (1 ± 0.3 mm,p < 0.001) for one method and in three coordinates for another method (x:0.1 ± 0.1 mm, y:0.4 ± 0.2 mm, z:0.4 ± 0.2 mm, p < 10-10). Within-method coordinate variability across participants is similar. CONCLUSION We describe a robust and precise method for CT DBS contact localization. Application revealed that acquisition head angle significantly impacts electrode position. DBS localization schemes should account for head angle.
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Affiliation(s)
- Mikhail Milchenko
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Abraham Z Snyder
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Meghan C Campbell
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joshua L Dowling
- Department of Neurosurgical Surgery, Washington University School of Medicine, (CB 8057), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Keith M Rich
- Department of Neurosurgical Surgery, Washington University School of Medicine, (CB 8057), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Lindsey M Brier
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joel S Perlmutter
- Mallinckrodt Institute of Radiology, Department of Radiology, Washington University School of Medicine, (CB 8225), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neurosurgical Surgery, Washington University School of Medicine, (CB 8057), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Neuroscience, Washington University School of Medicine, (CB 8108), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA; Department of Occupational Therapy, CB 8505, 4444 Forest Park Ave, St. Louis, MO 63108, USA; Department of Physical Therapy, CB 8502, 4444 Forest Park Ave, St. Louis, MO, 63108, USA
| | - Scott A Norris
- Department of Neurology, Washington University School of Medicine, (CB 8111), 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
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